I’m not getting all this fuss to stop a sugar tax that we all know is a good idea. Mayor Nutter’s proposal to tax sweet drinks is a progressive response to both a fiscal and a health problem. I understand the jobs issue is a concern, but people will continue to want their sugar fix. Manufacturers and bottlers are not going out of business anytime soon. Come on… one thing we know from cigarettes is that people will pay for their vices. The bigger issue is that the average consumer is unaware of just how much sugar they are ingesting everyday. In fact, thanks to the “low-fat” craze of the early 90’s, there is a misperception that sugar is okay that fat is not. Not exactly.

In Camden, the great work of the Camden Coalition of Healthcare Providers has been highlighted in the media for its ability to create cooperatives among the City’s healthcare leaders. One of their many projects concern diabetes and its impact on area residents. The Camden Citywide Diabetes Collaborative aims to improve the coordination of care for persons with diabetes. This includes improving self-care. Self-care includes education and that means reminding people that those sports drinks will not make you an athlete and massive, super-sized sodas is not a bargain in the end. At Our Lady of Lourdes Medical Center, where I work, we have been working with Dr. Jeff Brenner on this and other Coalition activities. We helped develop abillboard  (oll216_billboard_lo FINAL)that resided in the heart of Camden, on Federal Street, to bring attention to the issue. The Board, donated by PNC Bank, is just a step. But over here in Philadelphia, where I live, I’m a little disheartened by the reluctance of City Council to champion a cause that will certainly help to relieve the perfect storm of fiscal difficulties our city is facing.

But I also have a selfish reason to support the sweet drink tax. I give you Exhibit A: a typical clean up from the trash that makes its way to my house. Notice the soda bottles, coffee stirrers, cupcake wrappers, etc. I live on the unfortunate side of my block. That is the side that captures all of the trash that blows up on a windy day. I also live on the path between two schools. Exhibit B gives you an idea of what the kids are eating these days. I don’t mind sweeping my pavement, but it is depressing to see the amount of trash kids (and grownups) are eating and tossing. I cannot help but see the relationship between mental and physical health, between the well-being of an individual and the well-being of a community. I don’t think a tax on sugar is going to stop this overnight, but it might cause a few to stop and consider what they are putting into their body. It’s a start.

Friday we had our quarterly leadership development institute. It is sort of a retreat day where we focus on a particular topic or issue. This one was a reflection of last year’s accomplishments and next year’s goals, but the day began with a presentation of a report, the result of a effort by the New Jersey Hospital Association to obtain an independent and objective analysis (a “warts and all” review) of the state of New Jersey’s hospitals. They chose Accenture, which I think did a great job.

Before I worked at Lourdes, I worked for a hospital trade association and I’ve seen a lot of reports. Some can be self-serving, but this one is quite good because it demonstates that everyone needs to try harder in order to make real improvements in the in the delivery of care.

Up until now, I’ve spent my healthcare career in Pennsylvania. When I started at Lourdes last year, I could tell that the regulatory environment was much different, and in particular the organization of physicians and their relationships with hospitals. The Accenture presentation helped to clarify those differences and to point out how public policy, government programs and compensatory behavior conspire to create circumstances that impact hospitals, and more importantly, the patients they serve.

As just one example: New Jersey ranks 33rd in the use of hospice care among Medicare patients in the last stages of life. That means a lot of things. It means patients are probably being overtreated. It can mean that doctors and nurses are failing to have good, honest discussions with families. It means families and patients are not facing reality and demanding that “everything be done” when in fact the compassionate and decent thing would be to make sure the patient is provided as many dignified and pain-free last days as possible.

A summary of the report can be found at: http://www.njha.com/publications/HCNJ/HCNJV15No6.pdf

Nothin’ Left To Lose*

Imagine feeling so trapped and scared as a young man in 1968 that you enlist to go to Vietnam because you feel your chance of living is better there than on the street in front of your home? One wintry morning in 1978, I met such a man in an encounter that shattered the arrogance of my youth.

The two of us sat there in that cold and unfriendly room, part of a veterans’ psychiatric hospital 30 miles outside of Philadelphia. We sat there, face to face: one white, one black. There were similarities between the two of us. He was 28, I was 22. He was from West Philadelphia. I was from Northwest Philadelphia. He remembered Ritchie Allen, a Phillie who routinely rocketed homeruns out of Connie Mack Stadium. And so did I.

But it is the contrast that gnaws at me. I was the doctor. He was the patient. My father was a prominent surgeon who, to this very day, I idolize as my greatest role model in life. He only remembered seeing his father twice. He dropped out of high school at the end of 10th grade. I graduated from an exclusive prep school.

In the fall of 1968 , as a boy of 12, I loved to watch the Dallas Cowboys. In the fall of 1968, as a boy of 18, he enlisted to go to Vietnam to avoid being shot and killed by a rival gang on the streets of West Philadelphia.

The session was meant to be one in which a young doctor polished his interviewing skills by speaking with a patient dealing with mental illness. The hospital was filled with Vietnam veterans, so all 20 of my other medical school classmates were also conducting their own interviews on that day. The young man opened up “I enlisted to go to Vietnam because I thought my chances of living would be better there than on the streets of West Philadelphia with the gangs. I knew that I had made a mistake when the plane was flying me into Vietnam and I saw all the bombs going off in the distance.”

He was quiet and very sensitive. His voice quivered and his words were somewhat guarded, all so consistent with his story of violated youth. On this day, the doctor had no words of wisdom. On this day the doctor did the learning.

Today, I am a physician in an urban health center. I have carried his words with me across 28 years in time. They have never gone far from me. Periodically I have thought of him, although his name I have long forgotten. He taught me great humility on that day and I hope that I have carried that humility to the bedside of every patient for whom it has ever been my privilege to care. I now remember him as one of my greatest teachers in medical school.

I sit here in my office in Camden, New Jersey. It is on one of the top floors of the medical center and from it I can see far across the Delaware River where I have a clear panoramic view of the City of Philadelphia. Through the eyes of a now 50-year-old man, I see off in the distance that city’s tallest building, Liberty Place. It stretches proudly into the night sky, a well-lit beacon symbolizing the spirit of man reaching to new height. And its name reminds us all of a declaration in support of independence from fear and need so bravely articulated 230 years ago. With the advent of this New Year, so many of us celebrate the wonderful blessings that freedom in America has made possible. I am one of them.

But as I look out my window I do see an expanse of low-income, and even abandoned, housing that unfolds before me. I see Camden, a city known for its poverty and crime. And, in the distance, the City of Brotherly Love which was plagued with nearly 400 homicides in this year. I think of 47 million uninsured Americans struggling in a land of plenty. And I think of the similarities between the Iraq War and Vietnam.

As I look off towards Liberty Place, I think of my teacher and what he taught me that day. We hear so much about freedom these days. In this Holiday Season 2006 there are hundreds of thousands of Americans who will be in far off lands away from family for the cause of freedom.

For a moment I look out my window and think back to the fall of 1968. I see a young black man in the streets of West Philadelphia and he is tired and scared, trapped in a jungle of youth violence and poverty. He makes a decision to go to Vietnam in search of a better life? Perhaps Janis Joplin sung it best: “Freedom’s just another word for nothin’ left to lose.”*

Beautiful Sunsets,

Strawberry Fields

*From “Me and Bobby McGee”- sung by Janis Joplin, 1971; written by Kris Kristofferson